Treatment of Hallux Valgus with Forefoot Pain at the First MTP Joint and First Intermetatarsal Angle 9–14°
This protocol covers symptomatic hallux valgus presenting with forefoot pain localised to the first metatarsophalangeal (MTP) joint, where angular assessment identifies a hallux valgus angle of 15–20° or a first intermetatarsal angle of 9–14°.
Clinical Scenario
Patients typically present with gradual-onset forefoot pain at the first MTP joint that is worse on weight bearing. The deformity is sub-classified by specific angular thresholds — including a first intermetatarsal angle of 9–14° — that inform the management pathway.
Management Approach
Conservative measures form the basis of initial management: pain relief, footwear assessment and modification, and offloading of the first MTP joint. Physiotherapy directed at balance, proprioception, and core stability may also be included. Where specific clinical criteria are met, additional targeted interventions are available.
The complete sequencing, all criteria, and any further intervention options are detailed in the full structured protocol below.
Treatment Goals
Resolution of forefoot pain at the first metatarsophalangeal joint and improved foot function. Conservative treatments address symptoms but do not prevent or slow the progression of the underlying deformity.
References
DOI: 10.7759/cureus.96642
Symptomatic patients typically present with a gradual onset of sharp pain at the metatarsal phalangeal (MTP) joint that is worse on weight bearing.
NICE uses the HVA and intermetatarsal angle (IMA) to sub-classify the severity of the deformity.
Initial management of symptomatic HV involves conservative measures.
Patients should be educated on their condition, as well as receive a footwear assessment and relevant analgesia.
From here, patients may be provided with further options such as offloading orthotics.
Another common treatment is physiotherapy to improve patient balance, proprioception, and core stability.
Conservative treatments are aimed at symptom relief but do not prevent or slow down deformity progression.
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